Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD455033 | PA |
NPI | 1073707501 |
---|---|
Provider Name | Shristi Basnyat |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Estero, FL 34135-8129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 24/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0468631 | (05) | NJ |
103694000 | (05) | FL |